Transition Skills Assessment Created by Mrs. Medill for Home Living

Complete this survey as part of your transition planning.
Name: 


A red asterisk (*) indicates required questions.

  1. How many hours of sleep do you average during the school week?  *


  1. What is your usual bed time on a school night?*


  1. What is your usual bed time on a weekend night?*


  1. How often do you have to stay home from school because you are sick?  *


  1. Rank these from 1 to 5. 1 is your first choice and 5 is your last choice. When your are having personal problems, who would you go to for help?*
        1 2 3 4 5
    parents  
    brother or sister  
    friend or friends  
    teacher  
    no one  


  1. Do you have good health habits like avoiding tobacco, alcohol, or other harmful drugs?*
    Yes
    No


  1. Do you have good personal grooming and hygiene habits?*
    Yes
    No


  1. Which best describes your eating habits?*
    My family prepares meals and I eat with them.
    I usually have to make my own meals from what's at home.
    I eat fast food three or more times per week.
    I usually get one meal at home and one at school.
    I am often hungry.


  1. Do you exercise at least three times per week for at least 20 minutes? (not counting phy. ed.)*
    Yes
    No


  1. Rank yourself from 1 to 4. 1 is most like you and 4 is least like you. Which best describes how often you have fast food during the week.*
        1 2 3 4
    I do not get fast food.  
    I have fast food once a week.  
    I have fast food two to three times a week.  
    I get fast food more than three times a week.  


  1. For meals, what is your preferred drink?*
    water
    milk
    soda
    kool-aid
    juice boxes


  1. Can you make a meal for yourself? *
    Yes
    No


  1. Can you manage your time so that you get things done when they need to be done?*
    Yes
    No


  1. Do you have chores that you are expected to do around your house?*
    Yes
    No


  1. Do you pick out your own clothes?*
    Yes
    No


  1. Are you able to use basic tools like a hammer, pliers, or screw driver to make simple repairs at home?*
    Yes
    No


  1. How do you get up in the morning?*
    I get up for school on my own.
    A brother or sister wakes me up for school.
    A parent wakes me up for school?


  1. Which best describes how you take care of your money.*
    I usually save my money and don't buy much.
    I usually spend money as soon as I get it.
    Sometimes I save it, sometimes I spend it.


  1. Do you pay for things at the store without making money mistakes?*
    Yes
    No


  1. How often does this happen? You are not sure about how much change you should get back after making a purchase.*
    This hardly ever happens.
    This happens once in a while.
    This happens most of the time.


  1. How often does this happen? You buy something but when they ring up the price you do not have enough money?*
    This hardly ever happens.
    This happens once in a while.
    This happens most of the time.


  1. Do people like to borrow money from you because you forget about having them pay you back.*
    Yes
    No


  1. What should you do in an emergency situation, like someone getting hurt at home.*


  1. Which best describes you and medications?*
    I only take medicine when I am sick.
    I take my medications without being reminded.
    I have to be reminded to take my medications.
    I sometimes fake taking my medications.


  1. Do you know the difference between a serious and a minor injury?*
    Yes
    No





Mr. Burns
Worthington Middle School
Worthington, MN